Provider Demographics
NPI:1255186250
Name:OVUNC PEDIATRIC PULMONOLOGY MEDICINE CORP
Entity type:Organization
Organization Name:OVUNC PEDIATRIC PULMONOLOGY MEDICINE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BUGSU
Authorized Official - Middle Name:
Authorized Official - Last Name:OVUNC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-833-1334
Mailing Address - Street 1:5050 E 2ND ST # 41753
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-5361
Mailing Address - Country:US
Mailing Address - Phone:734-355-8762
Mailing Address - Fax:
Practice Address - Street 1:23600 TELO AVE STE 130
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4036
Practice Address - Country:US
Practice Address - Phone:310-833-1334
Practice Address - Fax:310-833-0270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Single Specialty